Tuesday, January 26, 2016

As we get older, we run into all
kinds of difficulties. Poor hearing, sexual dysfunction, memory problems
and arthritic joints, just to name a few. Bladder issues in particular can be
troublesome, interrupting sleep, making us dread long drives or forcing us to
visit the bathroom at an inopportune time.

As a prostate oncologist taking care of many men who are in their
60s and 70s, it’s no surprise that I hear a lot about urinary difficulties. These problems are often thought to result from prostate
enlargement, otherwise known as BPH. The swollen gland ends up pinching the
urinary passage way (called the urethra). Slow urination and incomplete
emptying of the bladder are the result.

Prostate gland enlargement with
incomplete bladder emptying can frequently be solved with common prescription
medications like Flomax, Rapaflo and Uroxatrol which relax the muscles in the
wall of the urethra and help to open up the passageway. Proscar and
Avodart can shrink the prostate but they also tend to shrink your libido. The
most popular treatment is a nonprescription—Saw Palmetto an herbal product
that works by relaxing the muscles in the urethra.

However, after doing thousands of color Doppler ultrasound
examinations, which by the way is the most precise way to measure the size of
the prostate, I have learned that BPH is a less common cause of men’s urinary
problems. So what is the primary reason for men’s urinary frustrations?
Prostatitis—low grade inflammation of the gland with secondary irritation.
What causes prostatitis? In a minority of cases it is due to bacterial
infection. When this type of prostatitis occurs it may improve with
antibiotics. But for the vast majority of cases we simply don’t know the
cause. Virus or autoimmune causes have been theorized but nothing has
been proven. Our ignorance, however, has nothing to do with its prevalence. It
is not widely realized, but almost allmen have
some degree of chronic inflammation in their prostate glands.

Though we don’t know the precise etiology, anti-inflammatory
medications can be quite effective at alleviating the symptoms of prostatitis.
Over the counter products like Aleve and Motrin are effective. Celebrex, is a
prescription anti-inflammatory agent that is billed as having less stomach
irritation. However, unless the pills are used continuously, the inflammation
comes back.

Recently, I have been introduced to a natural anti-inflammatory
substance discovered in the flower of the Crila plant. Several of our patients
tried Crila with notable improvement to their urinary symptoms. So far we have
not observed any side effects. To investigate Crila’s effectiveness
further, I have petitioned the manufacturer to provide a 3-month supply of
Crila to 15 of our patients at no cost. Patients who have problems with frequent
urination, a strong sense of urinary urgency or have to get up frequently at
night to urinate may want to consider contacting Sabrina in our office about
their eligibility for participating in this clinical trial.

Tuesday, January 12, 2016

Everyone is
excited about the latest craze in medical technology—genetic analysis of tumor
cells, which I’ll call GAT for short. The scientific progress that has been
made with GAT in my opinion is the second most
exciting area of advancement in medical technology today (see further below for
more about the first most exciting area). GAT technology is already being
commercialized for use in the medical marketplace in products like Prolaris
and Oncotype. This technology is able to
predict the aggressiveness of prostate cancers, enabling us to differentiate
between the men who need immediate treatment and those who can postpone
treatment safely.
The predictive power of GAT is certainly exciting, but there is already an
effective form of genetic testing available that has been around for more
than 40 years, the Gleason scoring system. The Gleason system relies on the
visual appearance of cells under the microscope to draw conclusions about their
inner genetic makeup. In the medical world, using the visual appearance of the
cancer cells is called phenotypic
analysis. GAT is genotypic
analysis. Drawing conclusions about underlying genetic makeup by simple
visual assessment is a pervasive in human experience. In courtship, we
rely on phenotypic analysis of the underlying genetic make-up of potential
spouses to form an opinion about their suitability as potential mates.
Perusal of the genetic pool of immediate family members provides further
insight.
So how can Gleason score draw conclusions about the underlying genetic
potential for tumor aggressiveness simply by looking at the appearance of cells
under a microscope? The answer is to do a comparison of the visual
appearance of cancer cells with the appearance of normal prostate cells. Normal
cells in the prostate perform varied functions but still work together as a
team. Specifically, healthy cells form into definable structures called
glands. In these glands some cells manufacture prostatic fluid, a complex
liquid comprising the ejaculate for the sperm to swim in. Other cells
organize to form ducts, a piping system to drain the fluid from the outer
periphery of the gland and channel it into the middle of the prostate so that a
large quantity of fluid can be expelled through the urethra at just the right
moment. All of these different cells work as a team and coexist in the
prostate functioning together in a structured glandular arrangement. When a
trained pathologist looks at tumor cells under the microscope he grades them by
the degree of cellular disorder. He is asking himself the question, “How
much do these cells retain the normal glandular characteristics of the prostate
gland?” If a cross section of the tumor looks like an unbroken sheet of
uniform cells, the cancer is high-grade; the cells have lost their ability to
cooperate with each other and form glands. The cancer cells have been honed
down into little race cars with only one mission, to aggressively pursue its
own replicative destiny. When tumors have this appearance they are graded as a
Gleason 9 or 10. On the other hand, if the appearance of the tumor shows
residual glandular components, it is less aggressive, perhaps a Gleason 7.
Gleason 6 “cancer,” the type the one that never spreads, looks almost like
normal prostate gland tissue. Predicting
future tumor behavior is obviously very important. How fast will it grow?
Is it likely to spread? How well can it be expected to respond to treatment? As
a result of decades of experience, doctors have learned to use the Gleason
scoring system to accurately predict the long-term outcome in individual
patients. The new GAT tests represent an important additional refinement,
further enhancing our ability to predict the future behavior of an individual
cancer. GAT holds one even bigger promise. In the future we believe GAT
testing will be a powerful aid in the selection of targeted therapy, i.e.,
picking cancer treatments with anticancer activity tailored to individual tumor
types. This hope, however, will have to be postponed until our limited
armamentarium of effective treatments is further expanded.
Now, what is
it that I consider to be the most exciting
area of medical progress? Since I am an impatient type of guy, someone who is
looking for quick results, I find immunotherapy more exciting than GAT. To
fully exploit the potential of GAT we will need to invent new pills for each of
the myriad of genetically different tumor types. Immunotherapy on the other
hand comes with its own “built-in” GAT system that enables it to target the
unique genetic signature of individual cancer cells. The immune system is so
smart, all we have to do is “flip the switch on” and starts cranking out
genetically targeted anticancer therapy. Recent developments in the field of
immunology are truly mind-boggling and hold promise for a big revolution in
cancer therapy within the next 5-10 years. I’ll try to address some of
these recent advances in an upcoming blog.

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PROSTATE SNATCHER VIDEOS

MARK SCHOLZ, MD

Mark Scholz, MD is board certified in medical oncology and internal medicine. He has been treating men with prostate cancer exclusively since 1995. He is the Medical Director of Prostate Oncology Specialists, Inc., and Executive Director of the Prostate Cancer Research Institute. He is an acknowledged expert on management and treatment for prostate cancer using hormone intervention, immunotherapy, chemotherapy and angiogenesis as well as vitamin, herbal and other forms of lifestyle counseling. His affiliations include St. John's Health Center, Marina del Rey Hospital and others. Dr. Scholz also served as an associate clinical professor in the department of Oncology at USC School of Medicine. Dr. Scholz volunteers for the Internet list “Patient to Physician,” found via Resources at www.pcri.org . You may also find current posts on twitter. www.twitter.com/markscholzmd

RALPH H. BLUM

Ralph H. Blum is a cultural anthropologist and author, graduated Phi Beta Kappa from Harvard University with a degree in Russian Studies. His reporting from the Soviet Union, the first of its kind for The New Yorker (1961—1965), included two three-part series on Russian cultural life. He has written for various magazines, among them Reader’s Digest, Cosmopolitan, and Vogue. Blum has published three novels and five nonfiction books. He has been living with prostate cancer, without radical intervention, for twenty years.

PROSTATE ONCOLOGY SPECIALISTS

Established in 1995, Prostate Oncology Specialists has earned national acclaim for its comprehensive approach to prostate cancer prevention and management. Under the direction of Medical Director Mark Scholz, M.D., Prostate Oncology Specialists employs a highly skilled team of physicians trained in oncology, radiology, hematology, and internal medicine who treat all stages of prostate cancer. Prostate Oncology Specialists are not wedded to any single therapy for prostate cancer, but rather advocate the exploration of treatment options that are customized and tailored to the unique needs of each individual patient. Treatments employed include active surveillance, testosterone deprivation, partial cryotherapy, seed implantation, intensity-modulated radiation, and surgery. Prostate Oncology Specialists’ ongoing mission is to uncover new medical breakthroughs in the treatment and management of prostate cancer.

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